You are on page 1of 47

Basic surgical principles

--
Revisited.
Aseptic techniques

Care and use of instruments
Aseptic techniques
 Too little attention
 Broad spectrum antibiotics  unjustified
security
 Lack of proper training to
 Surgeons

 Nurses

 others
Medico legal aspects
 Crime
 Act
 Intention
 Voluntarily
 Dishonestly

 Corruptly

 Malignantly

 Wantonly

 Rashly and negligently
Voluntarily
 Knowledge
A person is said to cause an effect
voluntarily when he causes it by means
whereby he intends to cause it, or by
means, which, at the time of causing those
means, he knew or had reason to believe
to be likely to cause it.
Rashly and negligently
 Not described in IPC
 Touching the sterile areas with unsterile
hands
 Diathermy injuries

 Keeping the instruments and wet packs
over the perineum
 Not using Mayo’s trolley
Theatre dress
 Pyjamas and shirts – both males and females
 Shirts to be tucked in.
 Shoes
 Cap and masks
 Controversial reports.
 Better to have both.
 Protect the theatre air from droplets and
desquamated epithelia.
 Masks should cover the nose and mouth
Common mistakes
 Gowning
 Improper packing
 Touching the areas which may come in contact
with sterile areas
 Cleaning the hands and forearm with gown
 Gloving
 Improper packing
 Improper wearing
 Improper conduct
Wearing gown.
 Separate towel to dry the hand; if gown
is used for the purpose the lower most
edge to be used.
 Adjusting the length of the sleeve shall
be done with ungloved hand holding in
the axilla of the gown.
 Other areas shall not be touched with
ungloved hand.
Wearing gloves
 Present system of packing makes it
impossible to wear the glove in a proper
way.
 The parts of the glove which come in
contact with the sterile areas shall not
be touched with bare hand.
 Double gloving is advisable with
questionable value.
After Gowning and gloving
 One shall not touch unsterile areas, shall
move 30 cm away facing the same
 One shall not touch sterile areas (other than
the operating field), shall move 30 cm away
facing the same
 One shall keep the hands up in the level of
chest  not in the axilla
 During painting the surgeon’s gown shall not
touch the table.
Others
 Movement shall be kept minimum
 One shall not touch sterile areas 
shall move 30 cm away facing the same
 The shirt to be tucked in
Sterile areas
 Sterilityis to be ascertained rather than
assumed.
 One person shall be kept to watch the
sterile area always
 Any breech in asepsis to be reported
forthwith.
Sterilization
 Methods
 Heat
 Moist heat
 Hot air
 Boiling ?
 Chemical
 Activated gluteraldehyde
 Formalin vapour
 Ethylene oxide gas
 Radiation
Moist heat
 Steam under pressure
Autoclave
 Advantages
 Easiest,safest, surest
 Fastest
 Least expensive
 Automatic
 Many items withstand repeated processing
Autoclave
 Disadvantages
 Preparation and package to be careful
 Item must be clean and free from grease
and oil
 Steam must have direct contact with all
areas of an item
 Timing depends on material and load 
chance of human error
 Impurities in water (steam)
Boiling
 NOT a method of sterilization. But can be
used as a disinfectant.
 Vegetative forms are killed in few minutes at
54 to 65oC.
 Certain bacterial spores will withstand 115oC
for 3 hours!
 No living things can survive saturated steam
at 121oC longer than 15 minutes.
And hence autoclaving.
Dry heat
 Anhydrous oils petroleum products,
bulk powders
Disadvantage
 Long exposure period.
Autoclaving
 Instruments not destroyed by heat.
 Bluntstainless steel instruments, gloves,
tubes, aprons and drapes.
 Sharp instruments not to be autoclaved.
 Tubes to be filled with water
 Trays to be separated by gauze
Activated gluteraldehyde
ADVANTAGES
 Non-corrosive
 Low surface tension.
 Not absorbed by rubber or plastics.
 Low volatility.
 Active at room – temperature
Activated gluteraldehyde
DISADVANTAGES
 Buffer to be added for activation.
 Gradually loses effectiveness.
 May cause skin irritation.
 Mild odour.
Activated gluteraldehyde
For instruments which are destroyed by
heat
 Bactericidal, pseudomonacidal,
Fungicidal and Virucidal in 10 minutes.
 Disinfection only !
 Tuberculocidal in 45 minutes.
 Sporicidal in 10 hours.
Formalin chamber
 To sterilize items which are destroyed
by heat
 Scopes, diathermy cables, etc.
Ethylene oxide
 Effective agent to sterilize items which
are destroyed by heat.
 Cannot be used in a hospital set up.
 Pre-sterilised in factory set up and
supplied
 Syringes, needles, plastics etc.
Radiation
 Effective agent to sterilize items which
are destroyed by heat.
 Cannot be used in a hospital set up.
 Pre-sterilised in factory set up and
supplied.
 No residual radio activity.
Instruments
 Identifythe instrument.
 Know the method of sterilization.
 Know the use.
 Know the method of use.
 Don’t use it for other purposes.
Use of instruments
 Curvature of instrument should follow
the curvature of the hand.
 Only one ratchet lock should be
applied.
 Cleaning ideally by ultrasonic waves.
 Light detergent may be used.
Mosquito Artery forceps
 Uses
 Tocatch a bleeding point
 DON’T use it for
 Ligature
 Dissection

 Holding gauze, mops, towels.
Artery forceps - Uses
 To Hold a bleeding point / blood vessel.
 For blunt dissection.
 Ligature.
 DON’T use it for
 Extractingneedle from tissues.
 Holding towels.
 To open bottles.
 To hold sponge.
Needle holder – Uses
 To hold a curved needle.
 To extract a needle from the tissue.
 To ligate.
 DON’T use it as a bone nibbler.
Mayo’s Scissors - Uses
 To cut tissues other than skin, bone and
tendons.
 Push cutting is useful not only to tailors but to
surgeons also.
 To do blunt dissections.
 Don’t use it for cutting suture material, gauze,
pad.
 Metzenbaum Scissors to be used for delicate
tissues.
Alli’s forceps and
other tissue holding forceps
 They are tissue forceps.
 To hold delicate tissues.
 DON’T use it for
 Holding the towel.
 Holding the apron of surgical team.
Intestinal occlusion clamp
 To occlude the lumen of intestine and
the blood vessels.
 Two or three ratchet locks may be
applied.
 DON’T use it for
 Holding skin grafting blade/razor blade
Anaesthesia screen
 Must to prevent contamination.
Recording
 Accurate recording of the procedure
 Will help to conduct studies – both
prospective and retrospective.
 Is important in medico-legal aspects.

 Help in surgical audit.
Doors
 Sliding doors are to be used.
 Opening and closure shall be kept
minimum.
 Traffic in and out of theatre to be
minimum
Mirror
 Mirror should be kept in the scrub area.
 This will facilitate the surgical team to
adjust the cap and mask correctly
before scrubbing.
Circulating nurse
 There shall be a circulating nurse.
 Presently the job is done by nursing
assistants and attendants
 Nursing assistants and attendants are
un-qualified to handle sterile things.
Mayo’s trolley
 The most versatile equipment.
 Unfortunately not used in our hospital.
 Advantages
 Prevent contamination of instruments.
 Prevent injuries to the patient.

 Provide an easy access to instruments.
Theatre head nurse
 Most powerful person of the theatre.
 Responsible for theatre discipline
 Maintains stock of medicines and
equipments
 Ascertains asepsis
 Supervises the nursing staff
Thank You
Medical Powerpoints

from mbbsBasic